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DSH460004G IHC Health Services Inc. DBA Intermountain Health McKay-Dee Hospital (Active)
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Main Details
Name
IHC Health Services Inc. DBA Intermountain Health McKay-Dee Hospital
Subdivision Name
Infusion Center - Infusion Services
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH460004G
Medicare Provider Number
460004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/11/2024
Participating Start Date
4/1/2024
Participating Approval Date
2/8/2024
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Intermountain Healthcare
Trever Porter, Finance Dir-MK
(801) 387-3767
Primary Contact
IHC Health Services, Inc.
Kevin Forbush, 340B Program Director
(385) 429-2887
Addresses
Street Address
201 W Layton Pkwy Suite 2050
Layton, UT 84041
Billing Address
IHC Health Services Inc. DBA Intermountain Health McKay-Dee Hospital
PO Box 30184
Salt Lake City, UT 84130
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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